Sunday, October 24, 2010

Health Care and the Campaign

A New York Times editorial on "Health Care and the Campaign" summarizes nicely the lies, distortions and disinformation about health reform the Republicans are purveying:

Lies. Here's John Raese, Republican candidate for Senator in West Virginia, on health reform: "From here on out under Obamacare, you're going to have a patient-bureaucrat relationship, because the first person that patient has to go to is a bureaucrat. That is called a panel."

There's simply no truth whatsoever to Raese's claim. Zero. Nada. But since the lie coincides with the widespread distrust of government that is at the heart of American political culture, it confirms a preconception. Wariness and skepticism about authority are good, but they can be turned into paranoia by Raese's lies and Palin's "death panel" nonsense. (See here for discussion of the paranoid style in American politics.)

Socialism. The Republican play-book calls for high frequency repetition of the "Obamacare is socialism" and "government takeover" mantras. As the Times points out: "What is true is that the law relies heavily on private insurers and employers to provide coverage. It also strengthens regulation of those insurers and provides government subsidies to help low- and middle-income people buy private insurance on the exchanges. Those exchanges will promote greater competition among insurers and a better deal for consumers, which last time we checked was a fundamental of capitalism. "

Billy Wharton, co-chair of the Socialist Party USA, agrees with the Times: "This is not a healthcare reform bill. It is instead a corporate restructuring of the American healthcare system designed to enhance the profits of private health insurance companies disguised with the language of reform."

Cost increases. The out-of-control cost trend is a key reason we need health reform, and premiums continue to go up well beyond the general rate of inflation. This gives Republicans a rhetorical meatball - "look, Obamacare is already driving costs through the roof the way we warned about!" (See here for a videoclip.) But as we teach medical students in their introductory courses, correlation doesn't establish causation. The primary harm of the Republican distortion is that it contributes to lack of public understanding of the primary drivers of the cost trend: excessive administrative costs, high prices for medical services, and inefficient provision of care.

Medicare scare tactics. Efforts to scare seniors is an election year ritual. When the Democrats were out of power they did just what the Republicans are doing now. Both parties understand that Medicare (a) is a crucial social program, (b) is very popular, but (c) is economically unsustainable as the baby boom ages. Clinicians who care for the elderly, adult children involved with their parents' medical care, and many seniors, recognize that Medicare needs to move away from uncoordinated fee-for-service treatment, through a combination of better integrated care (through medical homes and accountable care organizations) and wiser CMS oversight. This particular piece of Republican rhetoric is part of political silly season. Democrats are just as profligate in their use of Medicare scare tactics.

From Socialists to the Tea Party, no one loves Patient Protection and Affordable Care Act. Given the intensity of political passion, the enormous economic interests at stake, the complexity of health care, and the dismal state of public and political understanding, passing a comprehensive bill was a remarkable achievement. It's a last ditch effort to make a health system governed by market forces viable. The only alternative is some form of single payer system. If the Republicans succeed in tearing down the health reform process they'll be advancing their own nightmare vision!